In what HIMSS Analytics is calling the most extensive analysis to date of the clinical effectiveness of electronic health records, the organization has released the results of a new study which finds significant improvement in hospital performance and mortality rates among those with advanced EHR capabilities.
The value of EHRs has long been discussed in trade and consumer news, but until now evaluations have lacked comprehensive clinical data, claims HIMSS Analytics in a written statement. The goal of the study was to scientifically measure the clinical benefits of EHR adoption.
Leveraging HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) and mortality rate measures collected by Healthgrades across 19 unique procedure and condition based clinical cohorts, the study reveals that hospitals with advanced EHR capabilities demonstrated significantly improved actual mortality rates, most notably for heart attack, respiratory failure, and small intestine surgery.
The findings of this seminal study are highly encouraging to those seeking evidence supportive of the clinical benefits of the EHR, states the study. Improvements in the predicted mortality rate indicate that hospitals with advanced EHR capabilities are able to capture more information about the patient. This improved data capture involving the patients co-morbidities and other risks allow clinicians to better manage patients seen in the hospital, resulting in more positive predicted clinical outcomes.
Using data from the Centers for Medicare and Medicaid Services on more than 4,500 acute care facilities for the years 2010-2012, Healthgrades evaluated hospital quality across 32 different procedures and condition-based clinical groups. Of these cohorts, mortality was evaluated as an outcome in 19 of these groups.
The clinical outcome evaluation included five risk-adjusted service line models developed by Healthgrades: cardiac, critical care, gastrointestinal, neuroscience, and pulmonary. For each cohort a multivariate logistic regression model was created to determine the probability of a patient death. The actual mortality and the predicted mortality rate were then calculated for each hospital and a statistical test was conducted to determine if each hospital performs better or worse than expected.
According to HIMSS Analytics, most cohorts experienced improvement in predicted mortality rates when compared to hospitals with lower EMRAM scores. However, there were several conditions/procedures in which the predicted mortality rate appeared to be unaffected by the EMRAM score, including Coronary Artery Bypass Graft, Valve replacement, Pulmonary Embolism, and Neurosurgery. As a result, the study acknowledged that some cohorts may be better at utilizing EHRs to help document and communicate information about the patient to improve their care.
That the relationship between EHR capabilities and decreased actual mortality rates was not universal, suggests other forces not considered in this study may be at play, states the study. Organizational culture and process issues come top of mind underscoring the argument that having advanced technologies in place is not necessarily synonymous with high quality patient care. Yet, these findings do support the argument that investments in a robust EHR infrastructure are conducive to yielding clinical benefits.
HIMSS Analytics calls the findings of its analysis significant which warrant continued effort to scientifically analyze and communicate the clinical benefits of the EHR.
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